Cardiac Drugs

High Ceiling Loop Diuretics

Mechanism of block reabsorption of sodium and chloride, prevent reabsorption of water
action
Therapeutic uses hypertension, need for rapid dieresis is needed such as pulmonary edema, heart
failure
Side Effects/ dehydration, hyponatremia, hyponatremmia, hypochloremia, hypokalemia
precautions (note: loop diuretics do not spare potassium), hypoglycemia
Interactions Digoxin toxicity if hyokalemic, additive hypotensive effects with other HTN
drugs,
Nursing/ Patient monitor I&O, IV bolus should be 20 mg/min or slower, patients most likely will
teaching be on potassium supplement, teach client to report weight loss, dizziness,
weakness, and signs for low magnesium levels (twitching)
Common drugs furosemide (Lasix), bumetanide (Bumex)

Thiazide Diuretics
Mechanism of Block reabsorption of sodium and chloride, prevent reabsorption of water. (but
action in a different site than loop diuretics)
Therapeutic uses often first choice medication for HTN, edema and mild heart failure, liver and
kidney disease
Side Effects/ same as loop diuretics, these are also not potassium sparing
precautions
Interactions Same as loop diuretics
Nursing/ Patient same as loop diuretics
teaching
Common drugs hydrochlorothiazide (Hydrodiuril) most commonly referred to as HCTZ,
chlorothiazide (Diuril) Note: a lot of these end in azide

Potassium Sparing Diuretics

Mechanism of block the action of aldosterone (sodium and water retention), which results in
action potassium retention but secretion of sodium and water
Therapeutic uses Often combined with other diuretics for its potassium sparing effects, heart
failure, hyperaldosteronism
Side Effects/ hyperkalemia (note this is hyper not hypo), endocrine effects (impotence,
precautions menstrual cycle)
Interactions use with ACE inhibitors increases risk of hyperkalemia
Nursing/ Patient monitor potassium levels, teach client to self monitor BP
teaching
Common drugs spironolactone (Aldactone)
 Osmotic Diuretics
Mechanism of reduce intracranial pressure and intraocular pressure by raising serum
action osmolality, and drawing fluid back into vascular and extravascular space
Therapeutic uses prevent renal failure in causes of hypovolemic shock and hypotension, decrease
intracranial and intraocular pressure, promote sodium retention and water
excretion
Side Effects/ caution with patients with heart failure
precautions
Interactions furosemide contributes to overall effect by promoting excretion of the fluid that
is drawn into the vascular space
Nursing/ Patient daily I&O and serum electrolytes, signs for dehydration
teaching
Common drugs mannitol (Osmitrol)

Angiotensin-Converting Enzyme (ACE) Inhibitors

Mechanism of blocks production of angiotension II which leads to vasodilation, excretion of
action sodium and water, retention of potassium
Therapeutic uses Hypertension, heart failure, Myocardial infarction, Diabetic/ non-diabetic
nephropathy, patients at high risk for CAD or MI
Side Effects/ orthostatic hypotension, cough, hyperkalemia, rash, edema of tongue pharynx,
precautions neutropenia (low WBC)
Interactions additive hypotensive effects, increase levels of lithium, NSAIDS decrease
effectiveness
Nursing/ Patient almost all are PO, monitor BP, captopril 1 hour before meals, all others does not
teaching matter with or without food, must notify if cough develops
Common drugs captopril (Capoten), enalapril (Vasotec), lisinopril (Prinivil) Note: most end in
pril

Angiotensin II Receptor Blockers (ARBs)

Mechanism of block action of angiotensin II in body, results in vasodilation, excretion of
action sodium and water, retention of potassium
Therapeutic uses hypertension, heart failure, stroke prevention, delay progression of diabetic
nephropathy
Side Effects/ Angioedema, fetal injury. Biggest difference between ACE and ARBs is that
precautions cough and hyperkalemia are NOT major side effects of ARBs.
Interactions additive hypotensive effects with other antihypertensives
Nursing/ Patient with or without food
teaching
Common drugs losartan (Cozaar), valsartan (Diovan), irbesartan (Avapro), olmesartan
(Benicar)
 Calcium Channel Blocker
Mechanism of blocks calcium channels in blood vessels, leads to vasodilation, decreased
action force of contraction in myocardium
Therapeutic uses Angina, Hypertension, cardiac dysrhythmias,
Side Effects/ tachycardia, edema, orthostatic hypotension, constipation, suppression of
precautions cardiac function,
Interactions no grapefruit juice with nifedipine, verapamil, and diltiazem
Nursing/ Patient do not chew sustained release tabs, IV bolus over 2 - 3 minutes
teaching
Common drugs nifedeipine (Procardia), diltiazem (Cardizem), amlodipine (Norvasc) Note:
most end in pine

Alpha Adrenergic Blockers (sympatholytics)

Mechanism of alpha blockade results in venous and arterial dilation, smooth muscle relaxant
action
Therapeutic uses primary hypertension, some used for BPH
Side Effects/ orthostatic hypotension
precautions
Interactions additive hypotensive effects, NSAIDS decrease effects
Nursing/ Patient taken with food, take initial dose at bedtime to reduce the first dose
teaching hypotensive effect
Common drugs prazosin (Minipress), mesylate (Cardura)

Centrally acting Alpha agonists

Mechanism of act withing CNS to decrease sympathetic outflow, results in decreased
action stimulatino of adrenergic receptors, decreased cardiac output, vasodilation,
decrease BP
Therapeutic uses primary hypertension, possible for migraines, flushing from menopause,
ADHD
Side Effects/ drowsiness, sedation, dry mouth, rebound hypertension
precautions
Interactions additive hypotensive effect, MAOIs couteract antihypertensive effects of
clonidine, additive depressant effects with other CNS depressants
Nursing/ Patient larger dose at bedtime to decrease the occurrence of daytime sleepiness
teaching
Common drugs clonidine (Catapres)

Beta adrenergic Blockers (sympatholytics), aka Beta Blockers

Mechanism of blockade results in decreased HR, decreased myocardial contractility, decreased
action rate of conduction through AV node
Therapeutic uses primary hypertension, angina, tachydysrhythmias, heart failure, MIs
Side Effects/ Bradycardia, decreased cardiac ouput, AV block, orthostatic hypotension,
precautions rebound myocardium excitation, bronchoconstriction
Interactions calcium channel blockers intensify effects of beta blockers, additive
hypotensive effects
Nursing/ Patient patients not to discontinue medication without consulting provider, monitor HR,
teaching BP before giving med
Common drugs metoprolol (Lopressor), atenolol, metoprolol, note: most end in lol

All of the above generally used for hypertension, some for angina and heart failure

Cardiac Glycosides
Mechanism of positive inotropic effect: increased force of myocardial contraction (improving
action cardiac ouput), negative chronotropic effect: decreased heart rate (giving
ventricles more time to fill with blood)
Therapeutic uses heart failure, dysrhythmias
Side Effects/ dysrhythmias, cardiotoxicity:such as weakness, fatigue, anorexia (levels should
precautions be 0.8 to 2.0 ng/ml), GI upset, CNS effects (weakness)
Interactions with diuretics may lead to hypokalemia, ace inhibitors may lead to decreased
effects of glycoside, quinidine increases toxicity
Nursing/ Patient monitor digoxin levels closely, avoid OTC medications, observe for symptoms
teaching of hypokalemia
Common drugs digoxin

Adrenergic Agonists
Variety of drugs that includes:
Epinephrine: increases BP, treatment of AV block during cardiac arrest, bronchodilator, vasocontrictor
Dopamine: treatment for shock and heart failure, renal blood vessel dilator, vasoconsrtictor
Dobutamine: treatment for heart failure, increases heart rete, myocardial contractility

Cardiac Glycosides/ Adrenergic Agonists above generally used for heart failure

Nitrates
Mechanism of dilation of veins, decreases venous return (preload) which decreases oxygen
action demand
Therapeutic uses acute angina attack, or prophylaxis for chronic angina
Side Effects/ h/a, orthostatic hypotension, tolerance
precautions
Interactions additive hypotensive effect with alcohol, and other antihypertensives,
contraindication with Viagra
Nursing/ Patient sublingual tablets for rapid onset, sustained release tabs for long onset, during
teaching angina attack instruct patient to stop activity, patient can take up to three doses
in five minute intervals
Common drugs Nitrostat, Isordil, isosorbide (Imdur)
 Antidysrhythmic Medications
variety of drugs are used, most of them already discussed above, book goes into great deal of detail
Sodium channel blockers: Lidocaine (Xylocaine)
Beta blcokers: propanolol (discussed above)
Potassium channel blockers: amiodarone (Cordarone)
Calcium channel Blockers: verapamil (Calan) (discussed above)

Fibrates
Mechanism of decrease triglyceride levels, increase HDL levels
action
Therapeutic uses reduction of triglycerides, increase HDL
Side Effects/ GI upset, myopathy (muscle pain), hepatotoxicity
precautions
Interactions concurrent use with coumadin increased risk for bleeding, bile acid sequestrants
interfere with absorption
Nursing/ Patient take meds 30 min prior to breakfast and dinner
teaching
Common drugs gemfibrozil (Lopid), fenofibrate (TriCor)

HMG COA reductase Inhibitors (Statins)

Mechanism of decrease manufacture of LDLs, increase HDL, promotion of vasodilation,
action decrase in plaque site formation, decreased risk for thromboembolism
Therapeutic uses hypercholesterolemia, prevention of coronary events
Side Effects/ hepatotoxicity, myopathy, peripheral neuropathy
precautions
Interactions with fibrates increased risk of myopathy, grapefruit juice suppresses effects of
Statins
Nursing/ Patient obtain baseline liver, renal test, monitor HDL, LDL, tri levels
teaching
Common drugs simvastatin (Zocor), pravastatin (Pravachol), note: all end in statin

Cholesterol Absorption Inhibitor

Mechanism of inhibits absorption of cholesterol
action
Therapeutic uses help lower LDL levels with modified diets, used alone or with statins
Side Effects/ hepatitis, myopathy
precautions
Interactions bile acid sequestrants interfere with absorption
Nursing/ Patient instruct client to report muscle aches and pain, discontinue if CK levels are
teaching elevated
Common drugs Zetia. This is the only one according to ATI
 Bile -Acid Sequestrants
Mechanism of decrease in LDL
action
Therapeutic uses used as adjunct with a Statin to lower cholesterol levels
Side Effects/ decrease absorption of some medications and fat soluble vitamins
precautions
Interactions interfere with digoxin, warfarin, thiazides, tetracyclines
Nursing/ Patient patients should drink adequate amounts of fluid while taking sequestrants
teaching
Common drugs colesevelam (WelChol), cholestyramine (Questran)

Misc LDL and triglyceride lowering drugs:

Nicotinic acid
Niacin (Niacor), also raises HDLs

Anticoagulants/ Parenteral: inactivation of thrombin formation, inhibition of fibrin

heparin
enoxaparin (Lovenox)

Anticoagulants/ Oral: antagonize vitamin K, prevents synthesis of coagulation factors, vitamin K is

used for warfarin overdose
warfarin (Coumadin)

Antiplatelets: prevents platelets from sticking together

Aspirin
clopidogrel (Plavix)

Thrombolytic Medications: dissolve clots that have already been formed, by conversion of
plasminogen to plasmin which destroys fibrinogen and other clotting factors, treatment for acute MI, PE,
DVT, stroke
streptokinase (Streptase)
alteplase (tPA)